CHADS2 Score in Predicting Cerebrovascular Events - A Meta-Analysis

Santos, Cristina; Pereira, Telmo; Conde, Jorge

doi:10.5935/abc.20130068

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…Similar results were found in a meta-analysis performed by Santos et al who examined the use of the CHADS-2 score at predicting cerebrovascular events[9]. They found that CHADS-2 was able to identify patients at risk of stroke, regardless of whether AF was present or not.…”

Section: Stroke Risk Prediction In a General Population Without Afsupporting

confidence: 82%

Empirical anticoagulation for patients in sinus rhythm at high risk of ischaemic stroke: A review of current literature

Battipaglia¹,

O’Neill²,

Hogarth³

et al. 2017

WJC

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Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation (AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a cost-effective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.

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Section: Stroke Risk Prediction In a General Population Without Afsupporting

confidence: 82%

Empirical anticoagulation for patients in sinus rhythm at high risk of ischaemic stroke: A review of current literature

Battipaglia¹,

O’Neill²,

Hogarth³

et al. 2017

WJC

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“…An earlier meta-analysis 23 showed the association between a higher CHADS 2 score and the risk of stroke in AF patients. However, CHA 2 DS 2 -VASc had not yet been similarly evaluated.…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of CHADS2 versus CHA2DS2-VASc for Predicting Stroke and Thromboembolism in Atrial Fibrillation Patients Independent of Anticoagulation

Zhu¹,

Xiong²,

Hong³

2015

Texas Heart Institute Journal

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A trial fibrillation (AF), the cardiac arrhythmia most frequently identified in clinical practice, becomes more prevalent as patients age. This condition is characterized by several devastating sequelae, including stroke and systemic thromboembolism (TE).1,2 Atrial fibrillation is a leading cause of neurologic disability and death depending on the severity of cardioembolic stroke, so oral anticoagulation is crucial for high-risk patients who have AF. Nonetheless, hemorrhagic sequelae of long-term anticoagulation are often seen during stroke prevention in patients who have AF. To date, several risk-scoring systems have shown modest predictive ability for endpoint events and have been well validated in recent studies. Two of the most widely used scores for risk prediction, CHADS 2 and CHA 2 DS 2 -VASc, guide the optimization of therapy in patients who have AF, particularly if those patients are artificially categorized into low-, moderate-, and high-risk groups (Table I).3-6 The classical and revised CHADS 2 score is cumulative on the basis of 6 clinical features: congestive heart failure, hypertension, diabetes mellitus, and age ≥75 years (counted as 1 point each), and a history of stroke or transient ischemic attack (2 points). 4,5 In comparison, the CHA 2 DS 2 -VASc score, proposed as a complement to the CHADS 2 score, ranges from 0 to 9 points; the clinical features are congestive heart failure or left ventricular ejection fraction ≤0.40, hypertension, age 65-74 years, diabetes mellitus, vascular disease, and female sex (1 point each), and age ≥75 years and prior stroke, transient ischemic attack, or thromboembolism (2 points each). 6 In both systems, patient stratification into 3 risk categories-wherein a 0 score is low risk, 1 is intermediate risk, and ≥2 is high risk-has received particular attention in embolic risk evaluation and is widely included in guideline recommendations. 2 The likelihood of an embolic event is closely related to the total points recorded for a given patient, and anticoagulation is advisable for patients with a score of 2 or more points.7 However, it is unclear whether anticoagulation should be recommended for intermediate-risk patients. When comparing

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“…Chronic therapy with oral anticoagulant drugs plays a crucial role in AF treatment by significantly avoiding the risk of thromboembolic stroke, although it brings a risk of intracerebral, or other hemorrhage 8 . Warfarin remains the most frequent oral anticoagulant prescribed in Brazil due to its efficiency and low cost 6,9,10,11 .…”

Section: Introductionmentioning

confidence: 99%

Alarming lack of knowledge about antithrombotic therapy among patients with atrial fibrillation

Leitão

Moreira

Thiel

et al. 2018

Arq. Neuro-Psiquiatr.

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Large population campaigns have been conducted in Brazil to improve knowledge about the signs and symptoms of stroke and the importance of time to care. Objective: Parallel to these important actions, we aimed to evaluate the lay knowledge of patients with atrial fibrillation, a well-recognized etiology of stroke, adequate treatment and management of which can prevent up to 30% of cerebrovascular events. Methods: We questioned 143 patients with atrial fibrillation about the risks associated with the disease. Results: Ninety-one percent were on anticoagulation treatment. Of the total, 63.6% reported having been informed about the risks and benefits of anticoagulants but only 46.9% were able to correctly mention one of these risks. Ischemic stroke was identified as a risk by only 25.9% and hemorrhagic stroke was not mentioned. A CHADS2 ≥ 2 was scored by 84.0% of the patients. Conclusions: Our study showed an alarming knowledge gap in patients with atrial fibrillation. Difficulty in adherence to treatment resulting from the failure of this communication is possibly one of the factors responsible for the high incidence and recurrence of stroke, and should not go unnoticed.

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CHADS2 Score in Predicting Cerebrovascular Events - A Meta-Analysis

Cited by 5 publications

References 16 publications

Empirical anticoagulation for patients in sinus rhythm at high risk of ischaemic stroke: A review of current literature

Empirical anticoagulation for patients in sinus rhythm at high risk of ischaemic stroke: A review of current literature

Meta-Analysis of CHADS2 versus CHA2DS2-VASc for Predicting Stroke and Thromboembolism in Atrial Fibrillation Patients Independent of Anticoagulation

Alarming lack of knowledge about antithrombotic therapy among patients with atrial fibrillation

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